DR. MITAL SPATZ (NPI# 1134449747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134449747 |
| Entity Type | Individual |
| Full Name | DR. MITAL SPATZ |
| Credential | DDS |
| Practice Address |
2929 N Southport Ave Chicago IL 60657-6945 |
| Mailing Address |
2929 N. Southport Ave Tooth Buds Pediatric Dentistry Chicago IL 60657 |
| Practice Telephone | 7733288282 |
| Practice Fax Number | 7733288204 |
| Mailing Telephone | 7733288282 |
| Mailing Fax Number | 7733288402 |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2018-05-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 019028295 | IL | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
021002694 | IL | Dental Providers |
| Street Address |
2929 N SOUTHPORT AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60657-6945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881673671 | Angela Wilson Pennisi | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2006-01-11 |
| 1205203494 | Joseph Raymond Ascher | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2015-08-24 |
| 1790079077 | Boundless Health, LLC | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2011-06-04 |
| 1083936256 | Blaire Broers Brown | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2010-02-16 |
| 1336396985 | Stephanie Elizabeth Penny | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2008-08-26 |
| 1538296975 | Jessica Brelje | Physical Therapist | 2929 N Southport Ave, Chicago, IL 60657-6945 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303887 | Simone Paes | Behavior Technician | 3141 N Sheffield Ave, Chicago, IL 60657 | 2020-10-13 |
| 1821613175 | Samridhi Khatri | Internal Medicine | 836 W. Wellington Ave, Advocate Illinois Masonic Medica, Suite 1312, Chigaco, IL 60657 | 2020-06-12 |
| 1467074617 | Dewolfe Aesthetic Services Sc | Surgery | 3357 N. Southport Aveune, Chicago, IL 60657 | 2020-05-11 |
| 1790304657 | Mehr Amer Mjeed | Student in an Organized Health Care Education/Training Program | Advocate Internal Medicine Clinic, Advocate Illinois Ma, 836 West Wellington Avenue, Chicago, IL 60657 | 2020-04-10 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1306493408 | Art of Sight Eyecare, LLC | Optometrist | 2915 N. Broadway, Chicago, IL 60657 | 2019-08-22 |
| 1992359277 | Joseph Michael Rochford IIi | Counselor | 1358 W Belmont Ave, Unit # 202, Chicago, IL 60657 | 2019-07-25 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1003388810 | Evolve Wellness S.c. | Counselor | 2845 North Sheridan Road, Suite 708, Chicago, IL 60657 | 2018-12-19 |
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
| Find all providers in zip 60657 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528562253 | Rachel Vorwaller | Dentist | 1460 N Halsted St Ste 403, Chicago, IL 60642-2607 | 2018-03-19 |
| 1316393390 | Erin Marie Petrik | Dentist | 2530 N Clark St, Apt 203, Chicago, IL 60614-4972 | 2016-05-10 |
| 1720468598 | Mehedia Haque | Dentist | 2062 N Milwaukee Ave, Chicago, IL 60647 | 2015-06-05 |
| 1811300437 | Michaella Radich Heitzler | Dentist | 1611 N. Wolcott Ave, Chicago, IL 60622 | 2014-06-11 |
| 1356768030 | Esther Levine Pincus | Dentist | Chicago Dental Professionals, 2340 North Clybourn Avenue, Chicago, IL 60614 | 2014-03-19 |
| 1316382187 | Serena Mitchual | Dentist | 801 S Paulina St Rm 256, Chicago, IL 60612-7210 | 2013-05-07 |
| 1962790428 | Megan Davenport | Dentist | 1611 N. Wolcott Ave., Chicago, IL 60622-1362 | 2011-07-19 |
| 1295968121 | Smile Lee Faces | Dentist | 4197 S Archer Ave, Chicago, IL 60632 | 2009-08-26 |
| 1013147024 | Yummy Dental | Dentist | 3500 N Lincoln Ave, Chicago, IL 60657-1104 | 2009-07-24 |
| 1659513950 | Melissa Marie Connell | Dentist | 1611 Wolcott Ave., Chicago, IL 60622 | 2009-04-01 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.